The prognostic effect of concomitant COVID-19 with spontaneous pneumothorax.

Background: The aim of this study was to investigate the prevalence of novel coronavirus disease 2019 (COVID-19) in patients hospitalized with primary spontaneous pneumothorax and to evaluate its possible effects on the clinical course, treatment, and the prognosis. Methods: Between April 2020 and January 2021, a total of 86 patients (78 males, 8 females; mean age: 27±5 years; range, 16 to 40 years) who had no underlying lung disease and were diagnosed with the first episode of spontaneous pneumothorax were retrospectively analyzed. At the same time of diagnosis, all patients were screened for COVID-19 via polymerase chain reaction test of nasopharyngeal swabs. According to the test results, the patients were divided into two groups as COVID-19(+) and COVID-19(-). The duration of air leak, hospital stay, recurrence rates and treatment modalities, and mortality rates of the two groups were compared. Results: Following a pneumothorax diagnosis, 18 (21%) patients were diagnosed with COVID-19. In COVID-19(+) patients, the mean air leak and lung expansion duration were significantly longer (p<0.0001 for both). In these patients, the mean length of hospital stay was also significantly longer (p<0.0001). During the median follow-up of six months, no mortality was observed and the recurrence rate was similar between the two groups (p=0.998). Conclusion: Our study results suggest that COVID-19 negatively affects the recovery time in patients with spontaneous pneumothorax.

Prospective analysis of the physiological changes caused by prolonged use of N95-type masks.

INTRODUCTION: The clinical and physiological effects of long-duration use of N95-type masks without ventilation valves, on health-care workers during the coronavirus disease-2019 (COVID-19) pandemic, were evaluated. METHODS: All volunteering personnel working in operating theater or intensive care unit, using nonventilated N95 type respiratory masks, minimum for a 2-h noninterrupted duration were observed. The partial oxygen saturation (SpO2) and heart rate (HR) were recorded before wearing the N95 mask and at 1st and 2nd h. Volunteers were then questioned for any symptoms. RESULTS: A total of 210 measurements were completed in 42 (24 males and 18 females) eligible volunteers, each having 5 measurements, on different days. The median age was 32.7. Premask, 1st h, and 2nd h median values for SpO2 were 99%, 97%, and 96%, respectively (P < 0.001). The median HR was 75 premask, 79 at 1st h, and 84/min at 2nd h (P < 0.001). A significant difference between all three consecutive measurements of HR was achieved. Statistical difference was only reached between premask and other SpO2 measurements (1st and 2nd h). Complaints seen in the group were head ache (36%), shortness of breath (27%), palpitation (18%), and nausea feeling (2%). Two individuals took off their masks to breathe, on 87th and 105th min, respectively. CONCLUSIONS: Long duration (>1 h) use of N95-type masks causes a significant reduction in SpO2 measurements and increase in HR. Despite being an essential personal protective equipment in COVID-19 pandemic, it should be used with short intermittent time periods in health-care providers with known heart disease, pulmonary insufficiency, or psychiatric disorders.

Prognostic significance of pathological complete response in non-small cell lung cancer following neoadjuvant treatment.

BACKGROUND: This study aims to investigate the factors associated with pathological complete response following neoadjuvant treatment and to examine the prognostic value of pathological complete response in patients with non-small cell lung cancer undergoing surgical resection. METHODS: Between February 2009 and January 2016, a total of 112 patients (96 males, 16 females; mean age 60±8 years; range, 37 to 85 years) with the diagnosis of non-small cell lung cancer who underwent anatomical pulmonary resection after neoadjuvant treatment were retrospectively analyzed. Demographic, clinical, radiological, and pathological characteristics of the patients were recorded. The patients were classified as pathological complete response and nonpathological complete response according to the presence of tumors in the pathology reports. Predictive factors for pathological complete response and its prognostic significance were analyzed. RESULTS: The mean follow-up was 35±20 (range, 0 to 110) months. Of the patients, 30 (27%) achieved a pathological complete response. Reduction rate in tumor size was significantly higher in the responsive group (32.5±21.6% vs. 19.2±18.8%, respectively) and was a predictor of pathological complete response independent from the T and N factors (p=0.004). Survival of the responsive patients was significantly longer than unresponsive patients (75±9 vs. 30±4 months, respectively; p<0.001). During follow-up, tumor recurrence was seen in 30 patients. Recurrence was observed in only one patient in the responsive group, while 29 patients in the unresponsive group had recurrence or metastasis. CONCLUSION: Tumor shrinkage rate after neoadjuvant treatment in non-small cell lung cancer is a predictive factor for pathological complete response. Survival of patients with a pathological complete response is also significantly longer than unresponsive patients.

Prognostic Importance of the Lymph Node Factor in Surgically Resected Non-Small Cell Lung Cancer.

BACKGROUND: Patients with N1 non-small cell lung cancer represent a heterogeneous population. The aim of this study is to determine the difference of survival rate between subtypes of N1 disease in surgically resected non-small cell lung cancer patients and to compare the survival in these patients with multi-N1 and single N2 (skip metastasis) disease. METHODS: Patients who underwent anatomical pulmonary resection in our institution between 2007 and 2014 with a pathological diagnosis of N1 and single N2 positive non-small cell lung cancer were included in the study. N1 positive patients were divided into three groups as single hilar; single interlobar, lobar, or segmental; and multiple N1 positive patients. These groups were compared among themselves as well as with incidentally found single N2 patients. RESULTS: A total of 1,742 patients who had non-small cell lung cancer underwent anatomical lung resection. The survival was better in single hilar lymph nodes than other subtypes of N1 disease (p = 0.015). There was no statistically significant difference in terms of survival between the other subtypes of N1 disease (p = 0.332). The difference in survival for single N2 disease compared with multi-N1 was not statistically significant (p = 0.054). Also, when we divided the groups as single and multi-N1, there was a significant difference in survival (p = 0.025). CONCLUSION: Single hilar lymph nodes with direct invasion have better survival rate than other subtypes of N1. Also, patients with multiple N1 positive lymph nodes have similar survival results compared with single N2 patients. Our results should be confirmed with larger series to better explain N1 disease.

Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia.

INTRODUCTION: Dysnatremia is reported to have a prognostic effect in various diseases. A limited number of studies have been published on dysnatremiarelated parameters and clinical outcome in patients with pneumonia. The aim of the study is to analyze the factors related to baseline dysnatremia and to evaluate the clinical outcome of dysnatremia on hospital stay, 30-day and 1-year mortality in hospitalized patients with community-acquired pneumonia (CAP). MATERIALS AND METHODS: The study is a two-centre, retrospective, crosssectional study. According to the baseline corrected sodium values, hospitalized patients with CAP were grouped as hyponatremia (<135 mmol/L), normonatremia (135-145 mmol/L) and hypernatremia (> 145 mmol/L). RESULT: Of all the 471 patients included, 119 (25.3%) had hyponatremia and 25 (5.3%) had hypernatremia. Higher leucocytes and lower albumin values correlated with hyponatremia while female gender, higher leucocytes and urea levels correlated with hypernatremia. Baseline hyponatremia prolonged hospital stay (9.2 ± 5.6, vs. 7.5 ± 4.6, respectively, p= 0.001) and increased 1-year mortality. On the other hand, hypernatremia predicted 30-day (40%, vs. 10%, p<0.001) and independently predicted 1-year mortality (p< 0.001). CONCLUSIONS: In hospitalized patients with CAP, baseline hyponatremia prolongs hospital stay while hypernatremia signals a worse outcome both in the short term and long term.

Correlation between meteorological changes and primary spontaneous pneumothorax: Myth or fact?

BACKGROUND: This study aims to investigate the relationship between meteorological changes and the development of primary spontaneous pneumothorax. METHODS: Medical records of 1,097 patients ( 975 males, 122 females; mean age 23.5±4.2 years; range, 17 to 32 years) admitted to our hospital with a diagnosis of primary spontaneous pneumothorax between January 2010 and January 2014 were evaluated retrospectively. Daily mean values for air temperature, wind speed, humidity rate and atmospheric pressure values obtained from the local meteorological observatory were recorded. The four-year study period was separated into two groups as days with at least one primary spontaneous pneumothorax development (group 1) and days without any primary spontaneous pneumothorax development (group 2). RESULTS: Within the study period of a total of 1,461 days, 1,097 cases were recorded in 759 days during which primary spontaneous pneumothorax was observed. Eighty-nine percent of the patients were male. There was no significant difference between the groups in terms of mean air temperature, humidity rate, and wind speed. Atmospheric pressure was significantly lower in group 1 (p<0.001). Decrease in atmospheric pressure with respect to the previous day increased the risk of primary spontaneous pneumothorax development significantly (p<0.001). CONCLUSION: In our study, low atmospheric pressure and significant pressure decreases showed a strong correlation with primary spontaneous pneumothorax. Temperature, wind speed, and humidity values did not influence primary spontaneous pneumothorax development.

Primary Pulmonary Malignant Fibrous Histiocytoma.

Malignant fibrous histiocytoma (MFH) cases are classified within the group of nonclassified sarcomas. The etiopathogenesis is unclear; however, MFH commonly develops in scar tissue and in areas exposed to radiation. MFH is the most common soft tissue sarcoma in adults and may be borne in the lungs, chest wall, mediastinum, or other tissues. Primary MFH of the lung constitutes less than 0.2% of all pulmonary neoplasms; thus, an optimal treatment strategy has not yet been elucidated. We aimed to report a case of MFH of the lung with subsequent treatment administration.

Organizing Pneumonia as a Histopathological Term.

OBJECTIVES: Organizing pneumonia (OP) is an interstitial lung disease characterized by granulation tissue buds in alveoli and alveolar ductus, possibly accompanied by bronchiolar involvement. Histopathologically, OP may signify a primary disease and be observed as a contiguous disease or as a minor component of other diseases. In this study, the clinical significance of histopathological OP lesions and clinical and radiological features of patients with primary OP were examined. MATERIAL AND METHODS: Between January 2011 and January 2015, of 6,346 lung pathology reports, 138 patients with OP lesions were retrospectively evaluated. According to the final diagnoses, patients were grouped as reactive OP (those with final diagnosis other than OP) and primary OP (those with OP). Patients with primary OP were classified according to etiology as cryptogenic and secondary OP. Radiological evaluation was conducted within a categorization of "typical," "focal," and "infiltrative." RESULTS: Of 138 patients, 25% were males and the mean age was 54±14 years. Pathologically, 61% of patients had reactive OP and 39% had primary OP. All reactive OP lesions were reported using surgical specimens, and the most frequent primary diagnoses were malignancy (65%), infection (15%), interstitial lung diseases other than OP (7%), and bronchiectasis (5%). Other diagnoses included bullae, foreign body, hamartoma, bronchogenic cyst, and bronchopleural fistula. Of all the primary OP patients, 48 had cryptogenic OP and six had secondary OP. Radiological involvement was consistent with typical OP in 30%, focal OP in 63%, and infiltrative OP in 7% of the patients. All focal OP lesions were defined using surgical resections. Positron emission computed tomography (PET-CT) was recorded in 28 patients. In 11 patients, lymphadenomegaly was comorbid. The mean widest diameter of focal opacity was 2.7±1.2 (1.2-4.9) cm, and the mean the maximum standardized uptake value (SUVmax was 6.1±3.9 (1.7-16.7). CONCLUSION: OP lesions generally present as a minor component of other diseases. In patients with OP, cryptogenic OP and radiological focal OP is more frequently observed. Most focal OP lesions are detected using surgical resections because of malignant prediagnosis owing to elevated SUVmax.

The predictors of mortality in IPF - Does emphysema change the prognosis?

BACKGROUND: Combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) has been reported to be more common in male smokers. A number of studies comparing CPFE patients with fibrosis-only patients have reported a similar prognosis while others have reported a significantly shorter survival. OBJECTIVES: In present study, we aimed to compare baseline characteristics of patients with IPF according to emphysema presence. We asssessed the prognostic value of emphysema along with each other parameter. METHODS: We retrospectively reviewed the clinical, baseline radiological, laboratory and physiological parameters of 92 patients who were diagnosed with IPF. The patients were divided into two groups: those without emphysema (Group 1) and with emphysema (Group 2). All-cause mortality was recorded, and the impact of the variables on survival was evaluated. RESULTS: Emphysema was recorded in 23 patients, all of whom were male. While ever-smoker rate was higher in Group 2 laboratory and physiologic parameters were similar. Radiologically, the presence of honeycombing, ground glass opacity, the extension and symmetry of involvement did not differ between the Groups. The median survival time was 29±4 months. Patients in Group 1 and 2 had a median survival of 34 and 9 months, respectively. In univariate analysis; radiological presence of emphysema and honeycombing, male gender, lower baseline levels of albumin and oxygen saturation, forced vital capacity and carbon monoxide diffusing capacity were detected as predictors of mortality. CONCLUSION: In present study, IPF with emphysema was more common in male smokers. When emphysema accompanies IPF, life expectancy is remarkably worse, but not independently so.

Supervivencia en exacerbaciones de la enfermedad pulmonar obstructiva crónica que requirieron ventilación no invasiva en planta / Patient Outcome after Chronic Obstructive Pulmonary Disease Exacerbations Requiring Non-invasive Ventilation during Hospitalization

Introducción: La introducción de la ventilación no invasiva (VNI) durante las exacerbaciones agudas hipercápnicas de la enfermedad pulmonar obstructiva crónica (EPOC) en plantas de hospitalización general ha demostrado ser eficaz, pero hay escasos datos sobre el pronóstico de estos pacientes. El objetivo de este estudio fue investigar la evolución intrahospitalaria y a largo plazo de pacientes con exacerbaciones de la EPOC que requirieron terapia VNI durante su ingreso en plantas de hospitalización general. Métodos: En este estudio de cohortes retrospectivo y unicéntrico se incluyó a pacientes con exacerbaciones hipercápnicas de la EPOC ingresados en planta entre los años 2011 y 2013. Se recabaron datos clínicos, analíticos y de supervivencia tras una mediana de 27 meses y se analizaron los factores predictivos de la mortalidad durante el ingreso y a largo plazo. Resultados: Se registraron datos de un total de 574pacientes (357varones, edad media 68±11 años). Durante el periodo de hospitalización fallecieron 24pacientes (4,1%). Se observó que la mortalidad durante la hospitalización era mayor en los pacientes que presentaban concentraciones de hematocrito y albúmina más bajas y recuentos leucocitarios más altos en el momento del ingreso, y en aquellos con pH bajo y PaCO2 alta 24h más tarde. La mediana de tiempo de supervivencia de esta cohorte fue de 27meses. Las tasas de mortalidad a los 3 y 6meses y a un año fueron del 14,5, 19,5 y 30%, respectivamente. En el análisis univariante, se observó que la menor supervivencia a largo plazo estaba relacionada con la edad avanzada, un índice de Charlson alto y concentraciones de hematocrito y albúmina bajas en el momento del ingreso, y un pH bajo al cabo de 24h. En el análisis multivariante, los factores de predicción de la mortalidad más sólidos fueron la edad avanzada y las bajas concentraciones de albúmina. Conclusión: Tras una exacerbación de la EPOC que haya requerido VNI, la esperanza de vida es corta. El hemograma inicial y los resultados de la gasometría arterial del segundo día pueden pronosticar la mortalidad durante la hospitalización. Los indicadores más sólidos de mala evolución a largo plazo son la edad avanzada y las bajas concentraciones de albúmina. Es posible que estos pacientes requieran un seguimiento más estrecho

Introduction: Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. Methods: Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects’ clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. Results: A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24h PaCO2. Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. Conclusion: Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up

Patient Outcome after Chronic Obstructive Pulmonary Disease Exacerbations Requiring Non-invasive Ventilation during Hospitalization. / Supervivencia en exacerbaciones de la enfermedad pulmonar obstructiva crónica que requirieron ventilación no invasiva en planta.

INTRODUCTION: Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. METHODS: Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects' clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. RESULTS: A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24h PaCO2. Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. CONCLUSION: Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up.

Is single port enough in minimally surgery for pneumothorax?

BACKGROUND: Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined. METHODS: Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized. RESULTS: Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046). CONCLUSIONS: This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.

Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction with titanium mesh.

Primary malignant tumors of the chest wall are uncommon. Chondrosarcoma is the most common malignancy of the sternum. The current therapy for chondrosarcoma requires adequate surgical excision. A 52-year-old man presented with a lower-sternal mass. Thorax computed tomography (CT) revealed a well-lineated, hypodense and round mass, which highly suggested the sarcoma of the chest wall. The tumor involved 1/3 distal part of the corpus sterni. Incisional biopsy of the mass was reported as chondrosarcoma. In order to obtain disease-free surgical margins, 1/3 distal part of the sternum with costochondral junctions was resected and reconstruction of anterior chest wall was performed with titanium mesh. The postoperative course was uneventful. The titanium mesh provided the essential rigidity and minimal elasticity over the surgical wound. Our findings show that this technique is adequate even for reconstructing extensive defects of the anterior chest wall.